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"#$% '()*+ ,#)-"

S4 Beait Sounu: (oluei people - Stiff ventiicles) Stiff anu hypeitiophieu ventiicles Bypeitiophic heait
SS Beait Sounu: (noimal in young kius anu piegnancy) Congestive Beait Failuie & Bilateu caiuiomyopathy;
Nitial ieguigitation; Beaiu at left lateial uecubitus expiiing.
Ciescenuo-ueciescenuo miu-systolic ejection muimui Aoitic stenosis; may be uue to age-ielateu calcifieu aoitic
valve
Bigh-pitcheu blowing uiastolic muimui; wiue pulse piessuie;
heau bobbing
Aoitic ieguigitationinsufficiency.
0pening snap, Louu S1 + uiastolic muimui heaiu at apex; Nitial stenosis (Rheumatic fevei)
Bigh-pitcheu blowing holosystolic muimui: Nitial ieguigitationinsufficiency
Holosystolic, harsh-sounding murmur. Loudest at tricuspid area ventiiculai Septal Befect.
Niu-systolic click ovei the caiuiac apex Nitial valve piolapse; louuest uuiing valsalva maneuvei.
Niu-systolic ejection muimui heaiu in pulmonic aiea; Wiue fixeu
split S2
Atiial Septal Befect.
Ciescenuo-ueciescenuo muimui; haish systolic muimui heaiu
along left miuule to uppei steinal boiuei:
Pulmonaiy valve stenosis.
Continuous machine-like muimui: Patent uuctus aiteiiosus.
Bigh-pitcheu blowing holosystolic muimui; heaiu at the lowei
left paiasteinal aiea & Becomes louuei with inspiiation;
Tiicuspiu ieguigitation (coulu be uue to Ebstein anomaly oi
Iv uiug abuse). Piominent jugulai pulse:
Suuuen teaiing chest pain iauiating to the back; Aoitic uissection.

.(%"-/ If you can't memoiize all those uesciiptions, just iemembei this:
Mitral/tricuspid valves can't open (stenosis): diastolic murmur.
Mitral/tricuspid valves can't close (regurgitation/insufficiency/prolapse): (holo)-systolic murmur.
NOTE: only tricuspid regurg murmurs increase intensity during inspiration
Aortic/pulmonary valves can't open (stenosis): systolic murmur.
Aortic/pulmonary valves can't close (regurgitation/insufficiency/prolapse): diastolic murmur.

Additional Notes on Heart Sounds :
Right-sided murmurs increase on inspiration and left-sided murmurs increase on expiration.
Valsalva maneuver and standing: most murmurs diminish except hypertrophic cardiomyopathy and mitral valve prolapse.
Squatting and passive leg raising: most murmurs become louder except hypertrophic obstructive cardiomyopathy and mitral valve prolapse.
Handgrip exercise: murmurs of mitral regurgitation, VSD, aortic regurgitation=louder; Hypertrophic obstructive cardiomyopathy=decreases.